Estimating Global Changes in Routine Childhood Vaccination Coverage During the COVID-19 Pandemic, 2020-2021

Background: The COVID-19 pandemic has disrupted the distribution of routine immunizations globally. Multi-country studies assessing a wide spectrum of vaccines and their coverage rates are needed to determine global performance in achieving vaccination goals.Methods: Global vaccine coverage data for 16 antigens were obtained from WHO/UNICEF Estimates of National Immunization Coverage. Tobit regression was performed for all country-antigen pairs for which data were continuously available between 2015-2020 or 2015-2021 to predict vaccine coverage in 2020/2021. Vaccines for which multi-dose data were available were assessed to determine whether vaccine coverage for subsequent doses were lower than that of first doses.Findings: Vaccine coverage was significantly lower-than-predicted for 13 of 16 antigens in 2020 and all assessed antigens in 2021. Lower-than-predicted vaccine coverage was typically observed in South America, Africa, Eastern Europe, and Southeast Asia. There was a statistically significant drop in coverage for subsequent doses of the diphtheria-tetanus-pertussis, hepatitis B virus, pneumococcus, and rotavirus vaccines (but not the measles vaccine) compared to first doses in both 2020 and 2021.Interpretation: The COVID-19 pandemic exerted larger disruptions to routine vaccination services in 2021 than in 2020. Global efforts will be needed to recoup vaccine coverage losses sustained during the pandemic and broaden vaccine access in areas where coverage was previously inadequate. Governments should make efforts to improve the resiliency of immunization services in preparation for future pandemics.Funding Information: This research was partially supported by research grants from the Ministry of Education, Culture, Sports, Science and Technology of Japan (21H03203) and the Ministry of Health, Labour and Welfare, Japan (20HA2007).Declaration of Interests: The authors have declared no conflicts of interest.Ethics Approval Statement: Ethical approval was not required for this secondary analysis of publicly available data.